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PEDIATRICIAN'S TACTICS FOR ABDOMINAL PAIN IN CHILDREN
Ashuralieva Mavluda
Andijan State Medical Institute
Abstract:
Functional abdominal pain in children and adolescents is characterized by a wide
range of manifestations, does not belong to a separate nosological form, has clinical, prognostic
significance and maintains the interest of internists in diagnostics and treatment. Given the wide
variety of signs of the systemic nature of the process in childhood, it is advisable to
comprehensively examine patients with abdominal pain. Of fundamental importance for
pediatric practice is an accurate syndromic diagnosis, which determines the need and strategy of
treatment, while the tactical task of the doctor is to choose a drug with the greatest therapeutic
and least toxic potential.
Kеywоrds:
children, abdominal pain, trimebutine.
INTRОDUСTIОN
According to the latest research, abdominal pain is a clinical problem often encountered in
gastroenterological practice among children and adolescents, and is the main reason for seeking
medical attention and disrupting a child’s social adaptation [1]. Experts from the International
Association of Pain (IASP) defined it as an unpleasant sensation and emotional experience
associated with actual or potential tissue damage; as one of the types of sensitivity that arises as a
result of pathological impulses entering the central nervous system from the periphery without a
single universal stimulus [2, 3].
MАTЕRIАLS АND MЕTHОDS
Clinical example. A 7-year-old boy was admitted to the emergency department complaining of
sharp, spasmodic abdominal pain, nausea, and vomiting with bile. From the medical history:
episodes of abdominal pain appeared a year ago, lasting from 15 to 30 minutes, recurring at
different time intervals, not associated with food intake, physical activity, or defecation, and not
reduced by changing div position. According to the patient's mother, there was no weight loss,
fever, chills, change in urine and feces color, or jaundice. Trial use of antacids and
antispasmodics was not used. It was possible to establish that the day before this pain attack, the
boy was at a birthday party for his friend, where, naturally, there were dietary errors. Physical
examination: temperature 36.6 °C, no intoxication, lies on back, legs bent at the knees. The
abdomen is tense, painful on palpation in the periumbilical area, intestinal sounds are audible.
RЕSULTS АND DISСUSSIОN
Thus, despite the fact that the morphological substrate of abdominal pain could not be identified
in this patient, the described situation is typical and is often observed in pediatric practice.
Summarizing the results of the anamnesis and the actual objective assessment of the child's
examination, we can suspect functional disorders in the biliary tract (gallbladder) system, which
to this day retain a leading position in the structure of gastrointestinal diseases in children. Other
functional pathology of the gastrointestinal tract (functional gastric dyspepsia, irritable bowel
syndrome) was excluded based on a detailed analysis of the clinical picture and clear diagnostic
criteria for functional diseases of the gallbladder (according to the official recommendations of
the Rome Consensus III and IV).
The causes of abdominal pain in children are the subject of intensive research, but many
questions remain unanswered. At present, very convincing data have been obtained that pain is
an objective human sensation formed by central structures on the perception of impulses coming
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from the periphery [1, 4]. The latter are assessed by sensory receptors, the pain message is
transmitted through primary afferent fibers to the spinal cord, where it enters the synapses of
special areas of the midbrain, the pons and the diencephalon through ascending nerve pathways.
From these lower parts of the central nervous system, nociceptive (painful) notification can be
sent to the limbic and somatosensory areas of the cerebral cortex, where pain is detailed [5].
According to the latest data, the signal receptor apparatus includes two categories of sensory
receptors. The first group of receptors is located in the cells of peripheral organs and tissues: the
colon, small intestine, ureter, bladder, bile ducts, heart - and works on the principle of a specific
reaction to harmful stimuli [2]. Another family of afferent visceral receptors in pain control
mechanisms does not react in a standard way, but only to a high discharge of impulses. With a
normal range of irritation, receptors transmit physiological information about the organ
(mechanical, chemical, thermal or osmolar). In response to extreme stimulation, the
susceptibility of the receptor apparatus increases, pathological activation of these receptors
occurs with the induction of hypersensitivity, which is considered the main initiating factor in the
implementation of pain [3].
According to a number of authors, the most important role is played by specific nociceptive
receptors [4]. The more specific the receptor connections, the sharper and shorter the pain will be.
Subsequently, in accordance with the universal patterns of the signal cascade, additional
nonspecific receptors are connected with recurrent stress exposure. In this case, abdominal pain
intensifies, becomes more persistent, and strong interconnections are formed in the central
nervous system that support the persistence of pain. Psychological factors that determine the
complex components of psychosocial dysfunction are also important in predicting the transition
of pain to the chronic phase [4]. This information is fundamentally important clinically, since it
explains why chronic pain is much more difficult to treat than acute pain, and substantiates the
need for the earliest possible administration of drugs that eliminate abdominal syndrome.
Pathogenetic mechanisms of formation of pain sensations in patients with functional gastric
dyspepsia, functional disorder of the gallbladder, irritable bowel syndrome are obviously
multifactorial and have not been fully studied [5]. However, today visceral hypersensitivity of
the above-mentioned organs is considered a universal and relevant pathophysiological
mechanism in relation to abdominal pain [2]. Visceral hypersensitivity is the cause of formation
of excessive corrective response – excessively strong contraction and/or stretching of the organ
wall above the nociceptive threshold. Visceral hypersensitivity also develops as a result of
release of biochemical and immunologically active mediators (hydrogen and potassium ions,
serotonin, histamine, prostaglandins, bradykinin) into the intercellular fluid surrounding pain
receptors. This, in turn, disrupts the physiological and chemical environment around nociceptors
and increases their excitation [3].
СОNСLUSIОN
Thus, the data presented in this article clearly show that abdominal pain is a serious problem for
internists, requiring a differentiated approach. Most often, it occurs with functional disorders of
the gastrointestinal tract and is not always amenable to standard therapy. When using
antispasmodics, a number of problems arise, the main ones being the choice of drug,
determination of the daily dose and duration of treatment.
RЕFЕRЕNСЕS:
1. Sperber AD, Drossman DA. Functional Abdominal Pain Syndrome. The American Journal of
Gastroenterology, 2010, 105: 770-75.
2. ISAP, Pain: Clinical updates Vol. XX, issue 2 March 2012, Identification and treatment of
Neuropathic Pain in patients with cancer http: //www.iosp-pain.org.
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3. Beaulieu P, Lussier D, Porreca F, Dickeuson AH. Pharmacology of pain: ISAP Press 2010,
622 p.
4. Drossman DA. The functional Gastrointestinal disorders and the Rome III process.
Gastroenterology, 2016, 130(5): 1377-90.
5. Thompson WG. The road to Rome. Gastroenterology, 2016, 130(5): 1466-79.
